Ins & Outs of Data Management Post-integration

Aaron Wootton, MBA, manager of clinical informatics at Michigan Heart in Ypsilanti, Mich., says that a key step in the integration process is establishing a single patient numbering system.

With dwindling dollars and cuts to reimbursement, more and more cardiovascular practices have integrated with hospitals to keep their doors open. Data management challenges exacerbate the arduous integration process. While some have worked to create almost seamless systems, there are often several hurdles to overcome during the process.

As initiatives under the Health IT for Economic and Clinical Health (HITECH) Act push forward, hospitals will be required to meet meaningful use requirements. And, deciding how to marry disparate health IT systems between newly integrated practices will be key.

Contract and budgetary issues rise to the top as the most challenging aspects of a merger, but piecing together how to share patient data from a practice setting with a hospital or integrated delivery network may be an even more daunting task. There is no one-size-fits-all approach. Instead, the integration team will need to devise a plan to provide accuracy and connectivity during the data transfer process.

Not just patient data

Health IT systems have become the link between patient care and quality data tracking and reporting, and the EMR allows for the transfer of patient data to clinical registries, other facilities and affiliated practices. But, with facilities able to choose from more than hundreds of health IT vendors, when hospital integration takes place, it may involve incompatible systems.

The challenge is connecting these disparate health IT systems, merging master patient indexes (MPIs) and joining clinical and financial data into one sophisticated, yet simple system, says Harry B. Rhodes, MBA, director of practice leadership at the American Health Information Management Association. And, this is no inexpensive task.

For Appleton Cardiology, a 17-physician practice that integrated with ThedaCare, which has five-hospitals and 22-physicians serving northeastern Wisconsin, merging clinical data was a seamless process, but grasping how to transfer financial data was another story, says Larry Sobal, MBA, MHA, system vice president of cardiovascular services at ThedaCare.

Appleton physicians already had worked alongside hospital staff prior to the merger, and luckily, the practice and hospital were using the same EMR system. "This made it easy to push patient data over to the hospital setting," Sobal notes. However, since Appleton had been using a stand-alone billing and documentation application, the financial data could not be transferred to the hospital.

"Currently, we are living in two separate applications and we have found it to be very difficult to recreate patient information," says Thomas Strauch, manager of cardiovascular operations and finance at ThedaCare. Consequently, employees are forced to create financial statements each month using a manual, paper-based system.

"The system is currently incapable of doing this automatically and for now, this is the only way we are able to get a complete picture of our finances," Strauch says.

After the merger, Appleton's staff had to be trained on the hospital's inpatient billing system, but now, 11 months in, there is still no single, user-friendly accounting system to aggregate data, Sobal notes.

Piece by piece, putting it together

Last year, when Michigan's Saint Joseph Mercy Health System acquired Michigan Heart, a 34-cardiologist, eight-office practice, based in Ypsilanti, Mich., the brainteaser of the deal was figuring out how to push data from the practice side to the hospital setting.

"Our major challenge was ensuring that the existing practice system was speaking the same language as the hospital's system as we attempted to share patient data," says Aaron Wootton, MBA, manager of clinical informatics at Michigan Heart. "While you don't necessarily need to buy new infrastructure for a merger, you do need to build a bridge between the two existing infrastructures."

Most importantly, all parties need access to the appropriate data, says Wootton. Therefore, Michigan Heart worked with the St. Joseph's emergency room (ER) and other hospitals within the system to ensure that the ERs had access to medical records, so staff could look up patient data as quickly and efficiently as possible.

Marty Rosenberg, MS, managing director at Navigant Health in Atlanta, says while interfacing systems may help bridge the gap between practice data and hospital data, hospital systems could pay up to $30,000 for this capability, depending on the complexity of the system needed. And while interfacing systems provide a bridge between two disparate systems, they do not provide a catch-all solution, he says. Continuous upgrades are needed to meet HIPAA requirements.

For Wootton, another critical issue was establishing a single patient numbering system, or an MPI. "Once you have the patient identifiers aligned, everything builds off that, and you are then able to push over test results, patient records and billing data," says Wootton.

MPIs must be joined to merge records, which then allow staff to search across systems of record locator servers. Practices have three options: renumber all existing patient records, renumber the past few years' records or link them within the MPI. Software algorithm programs can help in the process, but, this is no easy feat.

"The cost of renumbering all existing records may outweigh the benefits," Rhodes says. Many facilities simply opt to map and link the patient numbers, rather than undergo a time-consuming and expensive renumbering process.

Overcoming the obstacles

Since many hospital networks' IT systems lack interoperability, they are turning to health information exchanges (HIEs) for hospital and data connectivity, Rhodes says. The private HIE is a web-based system that automates the transfer of health data that are stored throughout disparate systems within the hospital. With the help of the HIE, patient data can be transferred to authorized users, he notes. Additionally, the HIE can help connect the hospital, physician, labs, clinics, etc., and patient data in a timely manner.

"While there are solutions out there, the challenge will be making the decisions of how much time and money you want to invest in merging these systems together," Rhodes offers. He says that often hospitals and practices underestimate the time and resources needed to integrate disparate systems.

Because patient records are required to be retained for a period defined by state and federal law, it may be more efficient and affordable to keep both systems running rather than attempting to piece together pre-and post-merger patient data, Rhodes says. "Sometimes, it would just be easier and more cost effective to run parallel systems and use the HIE to help link these systems together."

In the era of hospital mergers, the role of the data governance manager has become more and more prominent, Rhodes says. "Data governance becomes important because you need someone who can say, 'All the records prior to the 2005 merger are on the x, y, z system and all those post 2005 are on the a, b, c system,'" he explains.

Embarking on hospital integration is burdensome enough, and data management post-integration adds to the challenge. In fact, time and costs associated with the data transfer process often are substantial. While the process is far from straightforward, ultimately the practices and hospitals know that the benefits of a functional data management system are worth the effort.